Florida’s Largest Pediatric Medicaid Provider Is Suing Over Denied Pay
Florida’s largest Medicaid pediatric provider is suing the DeSantis administration, claiming state health officials used flawed calculations when setting reimbursement rates for children’s care. Pediatric Associates filed notice on June 23, 2026, that it would seek $300 million in primary care Medicaid funding it says was withheld over the past 20 months under a revised payment schedule the Agency for Health Care Administration adopted in February 2025.
The dispute centers on applied behavioral analysis services, a therapy widely used for children with autism. AHCA revised managed care rates to account for ABA costs but, according to Pediatric Associates, the math was wrong. ABA spending in Florida has exceeded $2 billion in prior years, making any miscalculation in how those costs are spread across managed care contracts significant.
“Many pediatricians caring for children on Medicaid are now being paid less than it costs to provide care, placing these doctors in an untenable position: continue to treat children on Medicaid at a financial loss or exit Medicaid altogether.”
Attorneys for Pediatric Associates, court filing, June 23, 2026
Pediatric Associates serves more than 300,000 Medicaid-eligible children in South Florida, approximately 15% of the state’s entire pediatric Medicaid population. If the provider exits Medicaid or scales back services, those children lose access to primary care.
AHCA Acknowledged the Problem Before the Lawsuit
The agency’s own April 17, 2026, correspondence to contracted managed care plans conceded that including ABA services in value-based contracts “has the potential to result in access issues.” That letter encouraged health plans to negotiate independently with providers to offset financial losses. AHCA gave plans 45 days to reach agreements.
Pediatric Associates says it met with AHCA at least five times between January and May 2026 before resorting to litigation. The case will go before Florida’s Division of Administrative Hearings, where Pediatric Associates, represented by Greenberg Traurig, is asking an administrative judge to block the current rates and require AHCA to recalculate them from scratch.
What You Can Do Now
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Call your Florida state legislators using the Florida Legislature’s member directory and tell them to hold AHCA accountable for the February 2025 rate revision. Ask them to request a public audit of how ABA costs were calculated before more providers exit Medicaid.
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Contact AHCA directly. The agency’s consumer services line is (888) 419-3456. Tell them the current reimbursement rates are causing providers to leave Medicaid and that 300,000 children in South Florida need a corrected rate schedule now.
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Contact Florida’s Governor’s office at (850) 488-7146 and ask the DeSantis administration to negotiate in good faith with Pediatric Associates rather than waiting for an administrative ruling that could take months while children lose access to care.
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If your child is a Medicaid patient at Pediatric Associates, document any disruptions to your care and submit a complaint to the Florida Office of Insurance Regulation, which oversees the managed care plans that receive the disputed rates.
Sources
Florida Phoenix: Largest Medicaid Pediatric Provider Sues DeSantis Administration Over Pay Rates KFF: Medicaid Managed Care and Value-Based Payment Arrangements Florida Agency for Health Care Administration: Medicaid Managed Care Plans
[Quote: “Many pediatricians caring for children on Medicaid are now being paid less than it costs to provide care, placing these doctors in an untenable position: continue to treat children on Medicaid at a financial loss or exit Medicaid altogether.”, Attorneys for Pediatric Associates, court filing.
Florida Phoenix]